Ending maternal deaths in a world of 8 billion: How midwives save lives

PATHOUMPHONE DISTRICT, Lao PDR – “I feel proud and happy that the world population is reaching 8 billion, especially because I know that it is partly because of the good work of midwives as we work to save lives every day,” said 27-year-old Amina Singsavanh, a midwife working in Pathoumphone district, Lao PDR. 

Amina was a little girl when she began observing her mother’s work of supporting pregnant women and assisting them with labour and delivery. Witnessing firsthand the difficulties and pain these women endured, Amina started to consider becoming a midwife herself. 

“I began to have a feeling that I had to become a midwife like my mother. Besides, I can continue to save the lives of mothers and newborn children,” she said. 

As midwives, Amina and her mother, Simmaly have had a direct hand in helping the global population ascend to its highest-ever level – especially amid changes in Lao PDR that have resulted in the establishment of the country’s largest skilled midwifery workforce in decades. 

Between 2007 and 2020, Lao PDR’s cadre of midwives has expanded from 100 to more than 1,800. Meanwhile, the country’s maternal mortality rate has steeply dropped from 357 deaths per 100,000 live births in 2012 to 185 deaths per 100,000 live births in 2017.

But here as in the rest of the world, more skilled midwives are needed to help safeguard women and children from the preventable complications and illnesses to blame for most maternal and newborn deaths. “We will not realize our aspirations to reduce maternal and newborn deaths without midwives,” said UNFPA Executive Director Dr. Natalia Kanem in a May statement honouring midwives.

A changing field in a growing world

Simmaly used to work at a small, remote health centre in Champasak province with no specialized doctors or midwives. Though trained as a midwife, she served mainly as a general health practitioner. At times, she felt unequipped to handle some women’s maternal health challenges, and transferred their cases to hospitals.

“I didn’t have sufficient knowledge to advise them. I was not capable of suggesting what to do to save their lives and that of their babies,” she said.

Midwifery in Laos PDR has seen significant shifts in recent decades. In the 1980s, specific training for the profession was curtailed and integrated into nursing programmes, causing the number of skilled midwives to dwindle. With nurses more likely to serve as general practitioners, expertise in maternal health care ebbed. A UNFPA-supported assessment conducted in 2008 revealed that four out of five health workers had "limited competencies" to help women through pregnancy, labour and delivery.

Recognizing the need to address the country’s high maternal mortality rate, the Lao PDR government launched several initiatives to train and build up the country’s ranks of midwives – leading to improvements in service coverage and increased demand for essential services such as facility-based delivery and antenatal care. In 2016, the Ministry of Health called the training and deployment of community midwives across the country “a major achievement”.

“Maternal death means a great loss in any society – but maternal death is preventable, and we can address it by strengthening maternal care and community engagement to ensure safe motherhood,” said Ministry of Health official Aphone Visathep.  

With support from UNFPA, Lao PDR’s ranks of midwives grew from fewer than 100 to nearly 500 by the end of 2012, one year after the global population hit seven billion. A decade later, the world has added one billion more inhabitants to its populace – and Lao PDR’s cadre of midwives has more than tripled in size.

Simmaly’s daughter has been part of this expansion. Amina began her midwifery education course in 2013 and graduated a year and a half later. By 2015, she was working as a midwife in some of the country’s hardest-to-reach remote communities. 

“I was happy she chose to study midwifery,” Simmaly said. “I am looking forward to seeing her deliver quality care to improve the well-being of our people.”

Simmaly has recently recommitted to the career she and her daughter now share. Having decided it was time to refresh her midwifery training under the country’s new curricula, Simmaly graduated in 2022 and now works as a midwife only. “I want to save the lives of mothers and newborns,” she said.

How midwives will support the world’s next billion people

Research indicates that midwives empowered with education and support can deliver about 90 per cent of essential sexual, reproductive, maternal, newborn and adolescent healthinterventions. Meanwhile, universal coverage of midwife-delivered interventions could save 4.3 million lives per year, according to UNFPA’s 2021 State of the World's Midwifery report. 

But there currently aren’t nearly enough midwives to go around. UNFPA is collaborating with more than 120 countries to strengthen the quality of midwifery education and scale up midwifery policies and services around the world. UNFPA also provides targeted support to the 39 countries where maternal mortality rates are highest – helping to avert an estimated 66,400 maternal deaths between 2010 and 2015. 

And as the global population continues to grow, midwives like Amina and Simmaly will play a critical role in preventing maternal deaths, and in helping a new generation get the healthiest possible start in this world.

“I hope to see more people have better access to information and services so everyone can have a healthy life and be happy,” Amina said. “I feel hopeful as I see mothers and newborns being saved and having good health – more than ever before.”